tbuckley/cabot-search huggingface dataset:
Abstract 10605: Percutaneous Debulking of Tricuspid Valve Endocarditis in Severe Covid-19 Pneumonia After Prolonged Advanced Life Support: A Case Series
Authors: Kara F Morton, Brittain F Heindl, Samuel McElwee, Silvio Litovsky, Mustafa I Ahmed, Stephen Clarkson
Journal: Circulation (2022)

Background: Over the past two years, the utilization of venovenous extracorporeal membrane oxygenation (VV-ECMO) for the treatment of coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS) has increased. While supporting respiratory function, VV-ECMO requires large-bore indwelling venous cannulas which risk bleeding and infections, including endocarditis. Case Summary: We describe the cases of a 48-year-old female and 39-year-old male patient hospitalized for Covid-19 pneumonia who developed ARDS and right ventricular failure, requiring VV-ECMO and Protek Duo cannulation. The female patient was decannulated from VV-ECMO after 123 days, but subsequently developed a segmental pulmonary embolism and tricuspid mass measuring 6.4 x 5.5 x 0.5 cm (fig A). After 116 days of VV-ECMO support, the male patient developed a tricuspid valve vegetation measuring 1.4 x 1.1 cm (fig B) with an adjacent right atrial component measuring 2.1 x 1.3 cm. The Inari FlowTriever system was used to percutaneously remove both the pulmonary embolism from the female patient and the tricuspid masses from both patients. Pathological examination of the mass from the female patient demonstrated Candida albicans endocarditis in the setting of Candida fungemia (fig C). Pathologic examination of the specimens from the male patient demonstrated endocarditis consistent with Pseudomonas aeruginosa in the setting of Pseudomonas bacteremia (fig D). Both patients experienced resolution of fungemia and bacteremia after percutaneous vegetation removal, and after prolonged hospital courses were discharged with supplemental oxygen. Discussion: VV-ECMO and right ventricular support devices are invasive and associated with bloodstream infection and infective endocarditis. Percutaneous debulking of valvular vegetations, associated with these right-sided indwelling catheters, may be an effective method of source control to prevent progression to valve surgery.
Abstract 11004: Investigator-Reported versus Adjudicated Clinical Events for Worsening Heart Failure
Authors: Ryan R Keane, Aubrie M Carroll, jie-lena sun, Mohammad S Khan, Brooke Alhanti, Adrian F Hernandez, Javed Butler, Christopher OConnor, Robert J Mentz, Stephen J Greene
Journal: Circulation (2022)

Introduction: Clinical event committee (CEC) adjudication is the gold standard for event reporting in clinical trials. In some instances, investigator-reported events may be an appropriate substitute to reduce operational complexity and costs of heart failure (HF) trials, but the level of agreement between CEC and trial investigators for defining worsening HF (WHF) events is not well described. Methods: The ASCEND-HF trial compared nesiritide vs. placebo among patients hospitalized for HF, regardless of ejection fraction, and adjudicated endpoints through 30-day follow-up. This post-hoc analysis included patients with death or rehospitalization within 30 days. Concordance between the CEC and site investigators for WHF death and rehospitalization was measured using simple kappa (ĸ) statistics. Factors independently associated with discordance were identified using a backward selection model. Results: Over 30-day follow-up, there were 105 investigator-reported WHF deaths and 154 CEC-classified WHF deaths (p&lt;0.001), with a modest level of agreement (ĸ 0.59) ( Figure 1A ). For 30-day WHF rehospitalization, there were 355 events reported by investigators and 426 classified by CEC, with high levels of agreement (ĸ 0.77). Older age was independently associated with higher likelihood of CEC-investigator discordance for WHF death (OR 1.16 [1.01-1.33] per 5-year increase). For WHF rehospitalization, older age (OR 0.91 [0.84-0.98] per 5-year increase) and higher systolic blood pressure (OR 0.82 [0.71-0.94] per 10 mmHg increase) were associated with lower likelihood of discordance. Agreement for WHF endpoints varied by geographic region ( Figure 1B ). Conclusions: CEC and trial investigators had modest rates of agreement for characterizing WHF death and high rates of agreement for WHF rehospitalization. Multiple patient factors were associated with CEC-investigator discordance and levels of agreement for WHF endpoints varied across geographic regions.
Abstract 10429: When You Hear Hoofbeats, Think Zebras and Not Horses: A Case of Cardiac Tamponade Preceding the Diagnosis of Rheumatoid Arthritis
Authors: Annie J Tsay, Christopher W Hoeger, Hannah Gendelman, Brian Stout, Anne-Marie Anagnostopoulos
Journal: Circulation (2022)

Introduction: We present a case of a 50 year-old man who presented with one week of chest discomfort and ECG consistent with pericarditis (Fig. 1A) complicated by pericardial effusion. He rapidly developed cardiac tamponade with a pulsus paradoxus of 30mmHg and associated echocardiographic signs including RV diastolic collapse (Fig. 1B) and severe respiratory variation requiring pericardiocentesis (Fig. 1C). He was treated with high-dose indomethacin and colchicine 0.6mg twice daily with symptomatic improvement. Initial work-up for the etiology of pericardial effusion was notable for a borderline ANA of 1:40 and an RF of 20 IU/mL. CRP improved from 115.5 mg/L to 6.3mg/L with treatment. Two months later, he developed recurrent chest pain with new arthralgias and new morning stiffness in several joints after completing the course of indomethacin. A repeat ECG revealed normal sinus rhythm. He was restarted on high-dose indomethacin and referred to rheumatology clinic for further autoimmune work-up. This revealed an elevated anti-cyclic citrullinated peptide antibody IgG titer (&gt;250), which is highly specific for RA. He was started on methotrexate 15mg weekly for treatment of newly diagnosed RA. To date, he remains asymptomatic. Results: Conclusions: Cardiac tamponade as the initial presentation of RA has not been previously described, but has been seen in systemic lupus erythematosus. Few case reports of pericardial disease without tamponade as the initial finding of RA have been reported. Development of cardiac tamponade in RA is rare (&lt;1%). New clinical symptoms and a high index of suspicion should prompt repeat and expanded work up for rheumatologic etiologies of pericardial disease. While cardiac involvement in RA is known to increase mortality, outcomes have been improving due to novel anti-inflammatory therapies. This case serves as an example of the collaboration needed between specialties to make the correct diagnosis in cardio-rheumatology patients .
Abstract 10222: Impact of Bleeding Event for New Cancer Diagnosis in Patients With Antiplatelet Therapy After Percutaneous Coronary Intervention
Authors: Yuya Sakuma, Takeshi Shimizu, Yuta Kurosawa, Himika Ohara, Yukiko Sugawara, Yuki Muto, Yu Sato, Takatoyo Kiko, Akihiko Sato, Tomofumi Misaka, Akiomi Yoshihisa, Takayoshi Yamaki, Kazuhiko Nakazato, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2022)

Background: It has been reported that the bleeding event represents unmasking of an occult cancer in anticoagulated patients with atrial fibrillation. However, the impact of bleeding event in patients with antiplatelet therapy after percutaneous coronary intervention (PCI) for new cancer diagnosis remains unclear. Methods and Results: Consecutive 1796 patients with coronary artery disease who underwent PCI and taking antiplatelet therapy were enrolled. Patients taking oral anticoagulants were excluded, and relationships between bleeding event and new cancer diagnosis were examined. Among 1565 patients, 189 (12.0%) experienced any bleeding events defined as Bleeding Academic Research Consortium (BARC) type-2/3/5 bleeding, 78 (4.9%) experienced minor bleeding events defined as BARC type-2 bleeding, and 116 (7.4%) were diagnosed with new cancer during a mean follow-up period of 1528 days. Patients with any bleeding were older (71.3 vs. 68.8 years, P = 0.005) and had higher prevalence of being at Academic Research Consortium criteria for high bleeding risk (62.4% vs. 43.8%, P &amp;lt; 0.001) than those without bleeding event. Of 189 patients with any bleeding and 78 patients with minor bleeding events, 31 (16.4%) and 16 (20.5%) were diagnosed with new cancer, respectively. In the univariate Cox proportional hazard analysis, the incidence of new cancer diagnosis was higher in patients with any bleeding and minor bleeding events than those without bleeding event (hazard ratio [HR] 3.19, P &amp;lt; 0.001 and HR 5.70, P &amp;lt; 0.001, respectively). In the multivariate analysis after adjusting for confounding factors, any bleeding and minor bleeding events were the independent predictors of new cancer diagnosis (HR 2.27, P = 0.003 and HR 3.93, P &amp;lt; 0.001, respectively). In addition, any gastrointestinal bleeding and minor bleeding events were associated with higher rates of new gastrointestinal cancer diagnosis (HR 4.46, P = 0.041 and HR 6.73, P = 0.009, respectively). Conclusion: In patients with antiplatelet therapy after PCI, any bleeding and minor bleeding events were associated with subsequent new cancer diagnosis. Even minor bleeding should be taken care as the first manifestation of underlying cancer during antiplatelet therapy.
Abstract 10899: Excessive Right Ventricular Afterload in Pulmonary Arterial Hypertension: Effects on Diastolic Function and the Left Ventricle
Authors: Ilton M Cubero Salazar, Andrew Lancaster, Matthew Kauffman, Alexandra Weller, Catherine Simpson, Todd M Kolb, Rachel L Damico, Stephen Mathai, David A Kass, Ryan J Tedford, Paul Hassoun, Steven Hsu
Journal: Circulation (2022)

Introduction: Right ventricular (RV) diastolic dysfunction in pulmonary arterial hypertension (PAH) remains poorly understood. In this study, we used RV pressure-volume (PV) loops to assess RV diastology as a function of afterload in PAH. Methods: RV PV loops were prospectively measured in control (n=9) and PAH (n=39) patients at rest and during supine bike exercise. PAH patients were stratified by effective arterial elastance (Ea), a lumped measure of total afterload, into two groups: high afterload (HA, n=20) and severe afterload (SA, n=19). Results: PAH groups were matched with respect to age, sex, and PAH medication usage. Ea at rest and exercise was higher in SA PAH (1.8 vs. 0.6 mmHg/ml, P &lt;0.0001 at rest; 2.3 vs 0.8 mmHg/ml, P &lt; 0.0001 with exercise). In the SA group, RV end-diastolic pressure (RVEDP) was higher at rest (13.3 vs 7.6 mmHg, P = 0.0017) and rose markedly with exertion (23.4 vs 13.1 mmHg, P=0.0001). Because RV volumes changed similarly in both groups, SA patients exhibited stiffer RVs (dP/dV 0.30 vs 0.11 mmHg/mL, P=.024). To understand pericardial-interventricular interactions, we calculated the RVEDP-to-pulmonary capillary wedge pressure (PCWP) ratio and the left ventricular (LV) transmural filling pressure (LVTMFP). RVEDP/PCWP was substantially higher in SA (2.1 vs 1.0, P=.005). Therefore, even though PCWP rose considerably in SA (mean 16 mmHg), exercise LVTMFP was significantly reduced in SA vs HA PAH (-7.5 vs 2.55 mmHg, P=0.002). Along with reduced LV size seen by concomitant echo, we thus revealed blunted LV filling specifically in SA PAH. Accordingly, exercise cardiac index, stroke volume index, and LV stroke work index were all markedly reduced in SA PAH. Conclusions: Severe afterload in PAH results in high RV diastolic pressures and RV stiffening, which in turn blunt LV filling and LV output with exertion. Due to ventricular interactions, exercise PCWP may rise considerably in PAH, thus reducing its ability to differentiate from left heart disease.
Abstract 10890: A Simplified Method for Correction of Effective Regurgitant Orifice and Flow Underestimation by Pisa in Non-Circular Orifices: An in vitro Study
Authors: Waqas Hanif, Javier Arce, Mohammed Makkiya, Nicole Wake, Ythan Goldberg, Edwin Ho, Aldo L Schenone, Lili Zhang, Leandro Slipczuk, Min Pu, Mario J Garcia
Journal: Circulation (2022)

Introduction: The proximal isovelocity surface area (PISA) method has been validated for quantifying severity of mitral regurgitation (MR) in orifices with circular geometry. However, functional MR often has an elliptical orifice, which alters the proximal isovelocity contour from a hemisphere to a hemi-ellipsoid. Studies have previously shown that PISA underestimates regurgitant flow (RF) and effective regurgitant orifice (ERO) in functional MR. Hypothesis: The application of a simplified hemi-ellipsoid formula based on biplane color Doppler improves accuracy in calculating RF and ERO across elliptical orifices. Methods: An in vitro model for flow quantification was used for all experiments. Multiple size orifices with minor to major ratios ranging from 1:1 to 1:9 were constructed by 3D printing. Flow was adjusted at multiple intervals to generate peak flow velocities ranging from 4.1 to 5.5 m/s and aliasing velocities from 12 to 18 cm/s. Isovelocity contours were evaluated by biplane color Doppler (Figure 1A). RF and ERO were estimated using the traditional hemispheric PISA (HS-PISA) formula and a simplified hemiellipsoid formula (HE-PISA) based on two orthogonal diameter measurements (Figure 1A and 1B). The estimated RF and ERO values were compared and validated against those derived from a magnetic flowmeter (FM). Results: Isovelocity contours changed from hemisphere to hemi-ellipsoid orifices with increasing ellipticity ratios. HS-PISA significantly underestimated RF (116 ± 27 vs FM 155 ± 20 ml/s) and ERO (26 ± 4 vs FM 34 ± 1 mm 2 ). Underestimation was significantly reduced by HE-PISA (135 ± 17 ml/s and 30 ± 2.5 mm 2 , both p&lt;0.001). Conclusions: A simplified hemi-ellipsoid PISA method provides more accurate assessment of RF and ERO in regurgitant orifices with non-circular geometries.
Abstract 10425: Needle Fragment Embolization Leading to Cardiac Tamponade
Authors: Abdul H Azizi, Samir Mehta, Erin Fender, Erik Marshall
Journal: Circulation (2022)

Background: Intravenous drug use (IVDU) may rarely result in needle embolism (1). We present a patient with history of active IVDU who was found to have pericardial effusion causing tamponade from needle fragment embolization. Case: 41-year-old female with history of active fentanyl use presented with pleuritic chest pain and dyspnea. EKG was consistent with acute pericarditis and she was started on colchicine and ibuprofen with symptomatic improvement. CT scan of the chest revealed a linear radiopaque structure along the inferior margin of pericardium (Figure 1). She had asymptomatic hypotension and echocardiogram showed moderate sized pericardial effusion with early signs of cardiac tamponade. She underwent median sternotomy and surgical evacuation of~400 ccs of hemopericardium and retrieval of intrapericardial needle fragment with anterior right atrial exit site. She did well post-operatively. She had previously presented 10-months prior with neck pain and lateral radiograph of the neck showed a needle fragment over the distal cervical trachea (Figure 2). Patient left against medical advice prior to treatment. Decision Making: Pericardiocentesis was deferred and surgical alternative was chosen after multidisciplinary discussion as she was asymptomatic and there was concern for ongoing bleeding from the needle exit site. Treatment options include conservative clinical monitoring in asymptomatic patients, pericardiocentesis/pericardial window, and surgical exploration of the mediastinal cavity (1). Conclusion: We describe a case of needle fragment embolization leading to cardiac tamponade requiring surgical evacuation and retrieval of foreign body.
Abstract 10947: A Polygenic Risk Score Added to a QRISK2 Cardiovascular Risk Calculator Demonstrated Robust Clinical Acceptance in the Primary Care Setting
Authors: Ahmet Fuat, Ella Adlen, Mark Monane, Ruth Coll, Sarah Groves, Elizabeth Little, Jonathan Wild, Farzan J Kamali, yusuf soni, Shona Haining, Helen Riding, Carla Giner Delgado, Fernando Riveros-Mckay, Michael Weale, Vincent Plagnol, Seamus Harrison, Peter Donnelly
Journal: Circulation (2022)

Introduction: We have previously shown that combining a polygenic risk score (PRS) for cardiovascular disease (CVD), a numerical summary of an individual’s genetic predisposition to CVD, with standard clinical risk calculators such as ASCVD-PCE and QRISK results in improved estimates of CVD risk. Implementation of such a cardiovascular integrated risk tool (CVD IRT) into real world clinical practice is a key focus for further study. Hypothesis: We assessed the hypothesis that a CVD IRT can be incorporated into routine primary care. Methods: The Healthcare Evaluation of Absolute Risk Testing Study (NCT05294419) is a prospective trial recruiting up to 1,000 healthy participants undergoing health checks across 12 UK NHS general practices. Both QRISK2 and CVD IRT scores were generated and returned to clinicians, who then communicated the results to participants. The primary outcome of this study is operational success as well as feedback from health care providers (HCPs) and participants. The study also measures the impact of the CVD IRT on clinical decision making. Results: These are interim analyses. As of April 2022, 624 eligible participants (62% female, mean age 55) have been recruited. A total of 371 CVD IRT reports have been generated, with 100% of blood samples generating scores that were all returned within the designated time frame. Among the primary care HCPs, 89% (8/9) agreed that the incorporation of CVD IRT into routine care could be done in a straightforward manner. Among the participants who have completed a survey to date, 93% (125/135) would likely or very likely recommend the CVD IRT to friends and family. Average QRISK2 (6.3%) and CVD IRT (6.6%) risk scores did not differ significantly, but there were broad changes in risk among individual patients, with 5% (19/371) of patients crossing above the risk threshold to treat according to NICE guidelines (10-year risk ≥ 10%) as well as 3% (11/371) of patients reclassified as very high risk (10-year risk ≥ 20%). Conclusions: The rollout of an integrated risk tool combining polygenic risk into a standardized CVD risk calculator within primary care is feasible and well accepted by clinicians and participants. The CVD IRT results suggest clinically actionable changes in a substantial proportion of this population.
Abstract 10439: Assessment of Left Atrial Deformation in Patients With Total Anomalous Pulmonary Venous Connection by Two-Dimensional Speckle-Tracking Echocardiography - A Single-Center Retrospective Cohort Study
Authors: Ryusuke Numata, Kiyohiro Takigiku, Kohta Takei, Yohei Akazawa, Haruka Obinata
Journal: Circulation (2022)

Background: Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease of newborns characterized by insufficient left ventricle growth and diastolic dysfunctions. We hypothesized that reduced blood flow into the left heart in the uterus could also affect left atrium (LA) growth, leading to anomalies after birth. We compared the age-related changes in LA parameters detected using two-dimensional speckle-tracking echocardiography (2DSTE) in patients with TAPVC. Method: The LA datasets of 28 neonates with isolated TAPVC were analyzed before surgery and during follow-ups and compared with those of age-matched healthy controls (January 2009–2022). The LA strain (ε), indicating LA function, was analyzed using QLAB represented by reservoir (εR), conduit (εCD), and contractile (εCT) functions. LA pressure was determined by performing catheterization. Results: Compared to the control group, the TAPVC group had significantly smaller LA maximum size preoperatively and normal and larger time-dependent increase in the LA maximum and minimum size, respectively. All 2DSTE-determined LA functions showed significant reductions at all time points in the TAPVC group compared to those in the control group (median εR, εCD, and εCT; before surgery: 17.0 vs. 26.0, 12.9 vs. 15.9, and 6.3 vs. 10.4; follow up at 1-2 years: 30.0 vs. 45.7, 23.2 vs. 29.6, and 6.1 vs. 16.3; follow up at 5-7 years: 31.2 vs. 43.1, 25.0 vs. 31.2, and 5.2 vs. 10.8, respectively; p &lt; .01). However, compared to before surgery, εR and εCD did represent a significantly increased trend at follow-ups (median εR and εCD: 16.8→27.5 and 1.1→23%, respectively). Patients with pulmonary venous obstruction (PVO) at birth showed significantly decreased εR and εCD and higher LA pressure compared to those without PVO. Conclusion: This study showed that LA impairments existed even after repair in patients with TAPVC, suggesting that LA function loss mediated by less blood flow persist in childhood.
Abstract 10871: Income in Relation to Anxiety and Patient Engagement Among Stroke Survivors Using Smartwatches for Atrial Fibrillation Monitoring
Authors: Syed Naeem, Khanh-van T Tran, Jordy Mehawej, Tenes Paul, Andreas Filippaios, Eric Ding, Edith Mensah Otabil, Kamran Noorishirazi, Ziyue Wang, Darleen Lessard, Sakeina Howard-Wilson, Apurv Soni, Jane Saczynski, David D McManus
Journal: Circulation (2022)

Background: Smartwatches are FDA-approved to detect atrial fibrillation (AF). We examined the associations between income level with anxiety, patient activation, and daily wear time in stroke survivors using smartwatches for AF detection. Methods: We analyzed data from the Pulsewatch study, a randomized controlled trial (NCT03761394) that enrolled participants aged ≥50 years with a history of stroke or transient ischemic attack, a CHA 2 DS 2 VASc risk score ≥ 2, and no contraindication to anticoagulation. Participants in the intervention group wore a cardiac patch monitor in addition to a smartwatch and smartphone for AF detection, whereas participants in the control group wore only the cardiac patch monitor. At baseline, 14 days, and 44 days, participants completed General Anxiety Disorder-7 and the Consumer Health Activation Index, which examined anxiety and patient activation, respectively . Adherence to the Pulsewatch system was measured by watch wear time. A longitudinal linear regression model was used to examine associations between baseline income (earning &lt;$50K/yr. vs.≥$50K/yr.) and changes in anxiety, patient activation, and wear time over the study period. Results: A total of 95 participants were included in this study. Participants earning &lt;$50K/yr. were 54.5% male and 90.9% white, while participants earning ≥$50K/yr. were 59.7% male and 88.7% white. At baseline, history of renal disease (12.1% vs 1.6%, 0.029), statin use (84.9% vs 96.8%, 0.034), depressive symptoms (65.6% vs 35.5%, 0.004), and anxiety symptoms (54.5% vs 18.3%, &lt;0.001), were different between the income groups. The high-income group was associated with reduced anxiety and greater activation (β -2.60, p-value &lt;0.001; β 7.83, p-value 0.005, respectively) but not significantly associated with wear-time (β 0.20, p-value 0.50) among stroke survivors. Conclusion: Stroke survivors with high baseline income had reduced anxiety and greater engagement when randomly assigned to smartwatch use for AF detection. Baseline income may influence stress levels and engagement associated with smartwatch use. Studies are needed to evaluate how the prescription of wearable devices affects mood and activation among older adults from diverse socioeconomic backgrounds.